Accuracy and precision of intraoral scanners for shade matching: A systematic review.

STATEMENT OF PROBLEM: The use of intraoral scanners is rising in prosthetic dentistry; however, systematic analysis of their accuracy and precision for shade matching is scarce. PURPOSE: The purpose of this systematic review was to evaluate the accuracy and precision of intraoral scanners for shade matching. MATERIAL AND METHODS: In addition to a manual search, an electronic systematic search was conducted on MEDLINE/PubMed, EMBASE, Web of Science, Cochrane, and Scopus databases. English-language original studies published between January 1, 2010 and March 1, 2022 with intraoral or digital scanners were chosen based on the keywords of tooth color or shade selection or determination, color or shade matching, accuracy, validity, or trueness, and precision, repeatability, or reproducibility as inclusive criteria. Two reviewers independently performed the literature search, selected the studies, collected the data from the studies included, and evaluated the quality of the studies included using a quality assessment method and the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies. A third reviewer resolved disagreements. RESULTS: A total of 17 articles concerning the shade matching accuracy and precision of intraoral scanners were selected and reviewed. Among them, 4 articles evaluated only accuracy, 4 articles assessed only precision, and 9 articles investigated both accuracy and precision. Ten articles reported low levels of shade matching accuracy for intraoral scanners, while 11 articles reported high levels of shade matching precision for intraoral scanners. CONCLUSIONS: Based on the current literature, intraoral scanners show acceptable precision but unacceptable accuracy for shade matching.

Influence of coping and veneer thickness on the color of zirconia-based restorations on different implant abutment backgrounds.

STATEMENT OF PROBLEM: The effects of coping and veneer thickness on the color of zirconia-based restorations are unknown. PURPOSE: The purpose of this in vitro study was to evaluate the influence of coping and veneer thickness on the color of zirconia-based restorations on different implant abutment backgrounds and to define minimum coping and veneer thicknesses for the backgrounds investigated to achieve a target color. MATERIAL AND METHODS: Thirty zirconia disk specimens with thicknesses of 0.4, 0.6, and 0.8 mm and 30 veneering ceramic disk specimens with thicknesses of 0.8, 1.0, and 1.2 mm were fabricated. Three backgrounds were prepared: titanium alloy, zirconia ceramic, and base metal alloy. The zirconia specimens were placed on the backgrounds, and the veneering ceramic specimens were located on the zirconia specimens. Spectrophotometric measurements were made to determine CIELab values. Color difference (ΔE) values were calculated to measure color differences between the specimens and the A2 VITA classical shade tab. ΔE values were compared with a perceptibility threshold (ΔE=2.6). Repeated measures ANOVA, Bonferroni test, and 1-sample t test were used to analyze data (α=.05). RESULTS: Mean ΔE values ranged from 2.0 to 9.8. Coping thickness, veneer thickness, and their combination significantly affected ΔE (P<.001). CONCLUSIONS: To achieve the target color with zirconia-based restorations, regardless of the backgrounds tested, the minimum thickness of zirconia coping should be 0.6 mm, and the minimum thickness of veneering ceramic should be 1.2 mm.

Effect of screw access hole design on the fracture resistance of implant-supported zirconia-based restorations.

OBJECTIVE: To evaluate the effect of screw access hole design on the fracture resistance of cement-retained implant-supported zirconia-based restorations with screw access holes. MATERIALS AND METHODS: Thirty cement-retained implant-supported zirconia-based molar crown specimens were fabricated. The specimens were divided into 3 groups of 10: without access holes (C), with screw access holes (S), and with screw access holes accompanied with a surrounding zirconia wall (W). The veneering ceramic thickness was 0.8 mm in all groups. Implants were vertically mounted in a metal block. Abutments were screwed on the implants and the specimens were cemented to the abutments. A universal testing machine applied compressive forces to the specimens until fracture. Fracture resistance values of the specimens were measured. One-way analysis of variance (ANOVA) and Tukey HSD tests were used to analyze data (P < .05). RESULTS: The mean fracture resistance values were 5794.85 N for C, 2691.48 N for S, and 3878.06 N for W. The screw access hole design significantly affected the fracture resistance (P < .0001). Significant differences were found between C and S (P < .001), C and W (P < .001), and S and W (P = .026). CONCLUSIONS: The screw access hole decreased the fracture resistance. A surrounding zirconia wall for the screw access hole increased the fracture resistance. CLINICAL SIGNIFICANCE: Screw access hole design may affect the fracture resistance of cement-retained implant-supported zirconia-based restorations with screw access holes. This study introduced a screw access hole design to improve the fracture resistance of these restorations.

Comparison of dimensional accuracy of conventionally and digitally manufactured intracoronal restorations.

STATEMENT OF PROBLEM: Advances have been made in digital dentistry for the fabrication of dental prostheses, but evidence regarding the efficacy of digital techniques for the fabrication of intracoronal restorations is lacking. PURPOSE: The purpose of this in vitro study was to compare the dimensional accuracy of intracoronal restorations fabricated with digital and conventional techniques. MATERIAL AND METHODS: A sound mandibular molar tooth received a standard onlay preparation, and onlays were fabricated with 1 of 3 fabrication techniques. In group CC, the onlays were made after conventional impression and conventional fabrication of a resin pattern. In group CP, the onlays were made after conventional impression and 3-dimensional (3D) printing of the pattern. In group IP, the onlays were made after intraoral scanning, and 3D printing produced the resin pattern. Ten specimens in each group (N=30) were evaluated. Glass-ceramic restorations were fabricated using the press technique. The replica technique was used to assess the marginal fit. Each replica was assessed at 8 points. One-way ANOVA was used to compare the marginal discrepancy among the 3 groups. The Tukey honest significant differences test was applied for pairwise comparisons of the groups (α=.05). RESULTS: No significant differences were noted in the marginal discrepancy at the gingival margin among the 3 groups (P=.342), but significant differences were noted among the 3 groups in the pulpal (P=.025) and lingual (P=.031) areas. Comparison of the absolute discrepancy among the 3 groups revealed that only groups CC and CP were significantly different (P=.020) from each other. CONCLUSIONS: Within the limitations of this in vitro study, the conventional method yielded more accuracy than the 3D printing method, and no differences were found between the methods which used the 3D printer (groups CP and IP).

Effect of cement type on the color attributes of a zirconia ceramic.

PURPOSE: This in vitro study evaluated the effects of four different cements on the color attributes of a zirconia ceramic. MATERIALS AND METHODS: 40 zirconia ceramic disk specimens (0.5 mm thickness, 10 mm diameter, 0.1 mm cement space) were fabricated by a computer-aided design and computer-aided manufacturing system. The specimens were divided into 4 groups of 10 specimens and cemented to composite substrates using four different cements including: Glass Ionomer, Panavia F2.0, Zinc Phosphate, and TempBond. The L*, a*, and b* color attributes of the specimens were measured before and after cementation by a spectrophotometer. Additionally, ΔE values were measured to determine color changes for the groups and then compared with the perceptional threshold of ΔE = 3.3. Repeated Measures ANOVA, Tukey Post Hoc, Bonferroni, One-way ANOVA, and One-sample t-test tests were used to analyze the data. All tests were carried out at the 0.05 level of significance. RESULTS: Statistically significant differences were detected in the ΔE values for Zinc Phosphate (P<.0001) and TempBond (P<.0001) groups. However, there were no statistically significant differences in this respect for Glass Ionomer (P=.99) and Panavia F2.0 (P=1) groups. The means and standard deviations of the ΔE values for Glass Ionomer, Panavia F2.0, Zinc Phosphate, and Tempbond groups were 2.11±0.66, 0.94±0.39, 5.77±0.83, and 7.50±1.16 Unit, respectively. CONCLUSION: Within the limitations of this study, it was concluded that Zinc Phosphate and Tempbond cements affected the color attributes of the tested zirconia ceramic beyond the perceptional threshold. However, Glass Ionomer and Panavia F2.0 cements created acceptable color changes.

Effect of screw access hole preparation on fracture load of implant-supported zirconia-based crowns: an in vitro study.

Background. Fracture load of implant-supported restorations is an important factor in clinical success. This study evaluated the effect of two techniques for screw access hole preparation on the fracture load of cement-screw-retained implant-supported zirconia-based crowns. Methods. Thirty similar cement-screw-retained implant-supported zirconia-based maxillary central incisor crowns were evaluated in three groups of 10. Group NH: with no screw access holes for the control; Group HBS: with screw access holes prepared with a machine before zirconia sintering; Group HAS: with screw access holes prepared manually after zirconia sintering. In group HBS, the access holes were virtually designed and prepared by a computer-assisted design/computer-assisted manufacturing system. In group HAS, the access holes were manually prepared after zirconia sintering using a diamond bur. The dimensions of the screw access holes were equal in both groups. The crowns were cemented onto same-size abutments and were then subjected to thermocycling. The fracture load values of the crowns were measured using a universal testing machine. Data were analyzed with ANOVA and Tukey test (P < 0.05). Results. The mean fracture load value for the group NH was 888.37 ± 228.92 N, which was the highest among the groups, with a significant difference (P < 0.0001). The fracture load values were 610.48 ± 125.02 N and 496.74 ± 104.10 Nin the HBS and HAS groups, respectively, with no significant differences (P = 0.44). Conclusion. Both techniques used for preparation of screw access holes in implant-supported zirconia-based crowns decreased the fracture load.

Effect of Three Different Core Materials on Masking Ability of a Zirconia Ceramic.

OBJECTIVES: Masking ability of a restorative material plays a role in hiding colored substructures; however, the masking ability of zirconia ceramic (ZRC) has not yet been clearly understood in zirconia-based restorations. This study evaluated the effect of three different core materials on masking ability of a ZRC. MATERIALS AND METHODS: Ten zirconia disc samples, 0.5mm in thickness and 10mm in diameter, were fabricated. A white (W) substrate (control) and three substrates of nickel-chromium alloy (NCA), non-precious gold alloy (NPGA), and ZRC were prepared. The zirconia discs were placed on the four types of substrates for spectrophotometry. The L*, a*, and b* values of the specimens were measured by a spectrophotometer and color change (ΔE) values were calculated to determine color differences between the test and control groups and were then compared with the perceptual threshold. Randomized block ANOVA and Bonferroni test analyzed the data. A significance level of 0.05 was considered. RESULTS: The mean and standard deviation values of ΔE for NCA, NPGA, and ZRC groups were 10.26±2.43, 9.45±1.74, and 6.70±1.91 units, respectively. Significant differences were found in the ΔE values between ZRC and the other two experimental groups (NCA and NPGA; P<0.0001 and P=0.001, respectively). The ΔE values for the groups were more than the predetermined perceptual threshold. CONCLUSIONS: Within the limitations of this study, it was concluded that the tested ZRC could not well mask the examined core materials.

Effect of Coloring-by-Dipping on Microtensile Bond Strength of Zirconia to Resin Cement.

OBJECTIVES: Studies on the effect of coloring procedures on the bond strength of zirconia to resin cement are lacking in the literature. This study evaluated the effect of dipping of zirconia ceramic in different liquid color shades on the microtensile bond strength (MTBS) of zirconia ceramic to resin cement. MATERIALS AND METHODS: This in vitro study was conducted on 100 microbar specimens divided into five groups of B2, C1, D4, A3 and control (not colored). To prepare the microbars, 20 white zirconia ceramic blocks, measuring 5×11×11 mm, were dipped in A3, B2, C1 or D4 liquid color shades for 10 seconds (five blocks for each color shade) and five blocks were not colored as controls. All the zirconia blocks were sintered in a sintering furnace. Composite blocks of similar dimensions were fabricated and bonded to zirconia ceramic blocks using Panavia F 2.0 resin cement. Zirconia-cement-composite blocks were sectioned into microbars measuring 1×1×10 mm. The MTBS of microbars was measured by a testing machine. Data were analyzed using one-way ANOVA and Tukey's test. All tests were carried out at 0.05 level of significance. RESULTS: Statistically significant differences were found among the groups in MTBS (P<0.001). The D4 group had the highest MTBS value (39.16 ± 6.52 MPa). CONCLUSION: Dipping affected the MTBS of zirconia ceramic to Panavia F 2.0 resin cement; however, a similar pattern of change was not seen due to the different liquid color shades.

Steam sterilization effect on the accuracy of friction-style mechanical torque limiting devices.

AIM: This study was aimed to evaluate the effect of steam sterilization on the accuracy (within 10%) of friction-style mechanical torque limiting devices (F-S MTLDs) to achieve their target torque values. MATERIALS AND METHODS: Fifteen new F-S MTLDs were selected from Astra Tech (25 Ncm, Hader SA, La Chaux-de-Fonds, Switzerland), BioHorizons (30 Ncm, Dynatorq ITL, Irvine, California, USA), Dr. Idhe (15-60 Ncm, Dr. Idhe Dental, Eching/Munich, Germany). Every peak torque measurement was tested ten times before steam sterilization using Tohnichi torque gauge (6Tohnichi-BTG (-S), Japan). Steam sterilization was performed using a 100 cycle autoclave. Preparation steps were carried out for the devices before each autoclave sterilization cycle. Peak torque measurements were repeated after every sterilization cycle. Mean difference between the measured and the targeted torque values were evaluated before and after aging. Repeated-measures of ANOVA were used to compare the differences of accuracy between subjects. Bonferroni post-hoc test was used for pairwise comparison. RESULTS: Autoclaving resulted in an increase in the error values (the difference between peak torque and target torque values) in all the three groups studied (P < 0.05), with only Astra Tech devices showing >10% (maximum 12%) difference from their torque values in 5% of the measurements. CONCLUSION: Steam sterilization effect differs between target torque and measured peak values with an increase trend. The peak torque values showed a significant decrease for BioHorizons, while a significant increase was noted for Astra Tech and no significant change in Dr. Idhe group after sterilization. CLINICAL IMPLICATION: Within the limitation of this study the torque output of each individual device deviated in varying degrees from target torque values. However, the majority of the new frictional-style devices tested in this study, delivered fairly consistent torque output within 10% of their preset target values after sterilization. Astra Tech devices were the only one showing more than 10% difference from their torque values in 5% of the measurements. Combined effects of sterilization and aging still needs to be determined.

The effect of sterilization and number of use on the accuracy of friction-style mechanical torque limiting devices for dental implants.

BACKGROUND: Mechanical torque limiting devices (MTLDs) are necessary tools to control a peak torque and achieving target values of screw component of dental implants. Due to probable effect of autoclaving and number of use on the accuracy of these devices, this study aimed to evaluate the effect of sterilization and number of use on the accuracy of friction-style mechanical torque limiting devices (F-S MTLDs) in achieving their target torque values. MATERIALS AND METHODS: Peak torque measurements of 15 new F-S MTLDs from three different manufacturers (Astra Tech, BioHorizons, Dr. Idhe) were measured ten times before and after 100 steam sterilization using a digital torque gauge. To simulate the clinical situation of aging (number of use) target torque application process was repeated 10 times after each sterilization cycle and the peak torque values were registered. Comparison of the mean differences with target torque in each cycle was performed using one sample t test. Considering the type of MTLDs as inter subject comparison, One-way repeated measure ANOVA was used to evaluate the absolute values of differences between devices of each manufacturer in each group (α = 0.05). RESULTS: The results of this study in Dr. Idhe group showed that, mean of difference values significantly differed from the target torque (P = 0.002) until 75 cycles. In Astra Tech group, also mean of difference values with under estimation trend, showed a significant difference with the target torque (P < 0.001). Mean of difference values significantly differed from the target torque with under estimation trend during all the 100 cycles in BioHorizons group (P < 0.05). CONCLUSION: The torque output of each individual device stayed in 10% difference from target torque values before 100 sterilization cycles, but more than 10% difference from the target torque was seen in varying degrees during these consequent cycles.

Effect of the number of implants on stress distribution of anterior implant-supported fixed prostheses combined with a removable partial denture: a finite element analysis.

OBJECTIVE: The main goal of this study was to evaluate differences in stress distribution relevant to the number of implants under an anterior bridge when combined with a removable partial denture in the posterior region. MATERIALS AND METHODS: Four three-dimensional finite element models (3D FEM) were designed from a mandible containing an implant-supported bridge extending between canines, and a bilateral distal extension removable partial denture. A nonrigid connection was selected as the attachment method between the partial denture and the anterior implant-supported fixed prosthesis; 2, 3, 4 and 5 implants supporting the bridge all with 10mm length and 3.8 mm diameter were assessed. With the aid of the finite element program ANSYS 8.0, the models were loaded and von Mises stresses were evaluated. RESULTS: In spongy bone, stress forces showed a decrease from 2 implants to 4 implants but showed an increase in the 5-implant model. Stresses on cortical bone of terminal implants were in similar range in the 2-, 3- and 4-implant models. While, in the 5-implant model the amount of stresses on terminal implants increased dramatically. The stresses on implants were nearly similar in all models, with the greatest amount on terminal implants. CONCLUSION: Within the limitations of this study, 2-, 3- and 4-implant models showed less stress on cortical and spongy bone in comparison with the 5-implant model. The stresses transferred to implants were nearly similar.

The combined effect of dismantling for steam sterilization and aging on the accuracy of spring-style mechanical torque devices.

PURPOSE: This study aimed to assess the combined effect of dismantling before sterilization and aging on the accuracy (±10% of the target torque) of spring-style mechanical torque devices (S-S MTDs). METHODS: Twenty new S-SMTDs from two different manufacturers (Nobel Biocare and Straumann: 10 of each type) were selected and divided into two groups, namely, case (group A) and control (group B). For sterilization, 100 cycles of autoclaving were performed in 100 sequences. In each sequence, 10 repetitions of peak torque values were registered for aging. To measure and assess the output of each device, a Tohnichi torque gauge was used (P<0.05). RESULTS: Before steam sterilization, all of the tested devices stayed within 10% of their target values. After 100 cycles of steam sterilization and aging with or without dismantling of the devices, the Nobel Biocare devices stayed within 10% of their target torque. In the Straumann devices, despite the significant difference between the peak torque and target torque values, the absolute error values stayed within 10% of their target torque. CONCLUSION: Within the limitations of this study, there was no significant difference between the mean and absolute value of error between Nobel Biocare and Straumann S-S MTDs.

The effect of aging on the accuracy of new friction-style mechanical torque limiting devices for dental implants.

OBJECTIVE: High variability in delivering the target torque is reported for friction-style mechanical torque limiting devices (F-S MTLDs). The effect of aging (number of use) on the accuracy of these devices is not clear. The purpose of this study was to assess the effect of aging on the accuracy (±10% of the target torque) of F-S MTLDs. MATERIALS AND METHODS: Fifteen new F-S MTLDs and their appropriate drivers from three different implant manufacturers (Astra Tech, Biohorizon and Dr Idhe), five for each type, were selected. The procedure of peak torque measurement was performed in ten sequences before and after aging. In each sequence, ten repetitions of peak torque values were registered for the aging procedure. To measure the output of each device, a Tohnichi torque gauge was used. RESULTS: Before aging, peak torque measurements of all the devices tested in this study falled within 10% of their preset target values. After aging, a significant difference was seen between raw error values of three groups of MTLDs (P<0.05). More than 50% of all peak torque measurements demonstrated more than 10% difference from their torque values after aging. CONCLUSION: Within the limitation of this study, aging as an independent factor affects the accuracy of F-S MTLDs. Astra Tech MTLDs presented the most consistent torque output for 25 Ncm target torque.

The effect of steam sterilization on the accuracy of spring-style mechanical torque devices for dental implants.

BACKGROUND: Mechanical torque devices (MTDs) are one of the most commonly recommended devices used to deliver optimal torque to the screw of dental implants. Recently, high variability has been reported about the accuracy of spring-style mechanical torque devices (S-S MTDs). Joint stability and survival rate of fixed implant supported prosthesis depends on the accuracy of these devices. Currently, there is limited information on the steam sterilization influence on the accuracy of MTDs. The purpose of this study was to assess the effect of steam sterilization on the accuracy (±10% of the target torque) of spring-style mechanical torque devices for dental implants. MATERIALS AND METHODS: Fifteen new S-S MTDs and their appropriate drivers from three different manufacturers (Nobel Biocare, Straumann [ITI], and Biomet 3i [3i]) were selected. Peak torque of devices (5 in each subgroup) was measured before and after autoclaving using a Tohnichi torque gauge. Descriptive statistical analysis was used and a repeated-measures ANOVA with type of device as a between-subject comparison was performed to assess the difference in accuracy among the three groups of spring-style mechanical torque devices after sterilization. A Bonferroni post hoc test was used to assess pairwise comparisons. RESULTS: Before steam sterilization, all the tested devices stayed within 10% of their target values. After 100 sterilization cycles, results didn't show any significant difference between raw and absolute error values in the Nobel Biocare and ITI devices; however the results demonstrated an increase of error values in the 3i group (P < 0.05). Raw error values increased with a predictable pattern in 3i devices and showed more than a 10% difference from target torque values (maximum difference of 14% from target torque was seen in 17% of peak torque measurements). CONCLUSION: Within the limitation of this study, steam sterilization did not affect the accuracy (±10% of the target torque) of the Nobel Biocare and ITI MTDs. Raw error values increased with a predictable pattern in 3i devices and showed more than 10% difference from target torque values. Before expanding upon the clinical implications, the controlled and combined effect of aging (frequency of use) and steam sterilization needs more investigation.

Evaluation of "golden proportion" in individuals with an esthetic smile.

BACKGROUND: One of the most important tasks in esthetic dentistry is creating harmonious proportions between the widths of maxillary anterior teeth when restoring or replacing these teeth. The "golden proportion" is a main guideline introduced in this field. PURPOSE: This study aimed to investigate the existence of the golden proportion between the widths of the maxillary anterior teeth in individuals with an esthetic smile. MATERIALS AND METHODS: This study was conducted with 157 dental students (75 women and 82 men), with ages ranging from 18 to 30 years. Students whose natural smile did not develop any visual tension with regard to the study's and their own criteria were selected as having esthetic smile. An image measurement program was used to measure the apparent mesiodistal widths of six maxillary anterior teeth on the scanned photographs of these subjects. The existence of the golden proportion was investigated in the width ratios of maxillary anterior teeth. RESULTS: The golden proportion was not found to exist between perceived maxillary anterior teeth widths of individuals with an esthetic smile. CONCLUSION: The golden proportion is not a common factor in esthetic smiles. CLINICAL SIGNIFICANCE: This article suggests considering the dentofacial specificities of each individual and also the wide variety of natural teeth proportions when restoring or replacing the maxillary anterior teeth. However, individual cultural characteristics and perception of beauty must be considered.